Albuquerque Area Model Diabetes Program

Albuquerque Service Unit Model Diabetes Program
Zuni Community Health Model
Zuni Service Unit Model Diabetes Program

Albuquerque Service Unit Model Diabetes Program
Albuquerque, New Mexcio

Norma Cruz, R D, Coordinator
PHS Indian Hospital
801 Vassar Drive, N E
Albuquerque, New Mexico 87106
Phone: (505) 256-4017
FAX: (505) 256-7697
E-mail: Norma.Cruz@ihs.gov

Program Description

The Albuquerque Service Unit (A S U) Diabetes Program began in 1979 to provide services at seven clinic sites. Services include clinical care and community interventions. The multidisciplinary staff, with 68 years of cumulative diabetes experience, includes four certified diabetes educators, two part-time physicians and support staff. Current registry shows approximtely 1,800 patients with diabetes.

Diabetes Clinics

• Clinical services at seven New Mexico sites provide comprehensive care to people with diabetes
• Services include diabetes treatment and prevention of kidney disease, eye disease, heart disease, stroke, amputations and cancer. Prenatal care and diabetes prevention services are also provided
• Diabetes and nutrition education and foot care are provided at all clinics
• Diabetes Management Guidelines and IHS standards of care are used to guide testing and therapy. A yearly chart audit is conducted and goals & program changes are based on the results
• Awarded the American Diabetes Association Provider Recognition Certificate in December, 1999.

Community Services

• The A S U Diabetes Program partners with communities, including tribal grant programs, to develop health interventions. This includes consultations, technical assistance and direct education services such as health fairs, cooking classes and support groups
• Monthly training for tribal diabetes grant staff is provided based on the training needs of A S U tribes but is open to all tribes.
• Quarterly meetings for tribal diabetes staff are coordinated throught the program

Resource and Products

• Educational materials, curriculum and programs are developed and tested by the program staff. These have included:
• Living Well with Diabetes-- a 6-week class to help people learn the skills needed to live well with diabetes. This program provides practical information in diabetes and how to care for it.
• Newly Diagnosed Program--a comprehensive education curriculum for all newly diagnosed D M patients
• Trimdown--a 6-week class designed to help people lose weight by changing eating and exercise habits. This program can help people to control diabetes, high blood pressure and high cholesterol.
• Wellpower--a quarterly newsletter on diabetes and general health for A S U Diabetes Program patients
• Development of numerous education materials, some have been adapted for widespread use in I H S.

Education

• Individual diabetes self-management sessions and medical nutrition therapy by certified diabetes educators are available at all sites
• group education is also provided in a variety of clinic and community settings.
• The A S U Diabetes Program provides education for medical staff, C H R s, tribal health staff, nurses, medical residents, University of New Mexico students, and other health care providers. This is done through formal training sessions, mentoring and preceptorships. Training is provided at A S U, the I H S Albuquerque Area and at other sites nationally.

Unique Contributions

• First program in I H S awarded American Diabetes Association Diabetes Education Recognition-able to share lessons learned, resources and curriculums developed Also awarded American Diabetes Association Provider Recognition Certificate that acknowledges program provides high standard of diabetes care and treatment.
• Leadership and participation in national and regional groups developing policy, programs and materials. Recent examples include Albuquerque Area I H S disease guidelines, I H S Diabetes Education Curriculum, I H S Diabetes Education Standards, and I H S automated diabetes audit, American Association of Diabetes Educators and I H S Speciality Practice Group.

Zuni Community Health Model
Zuni, New Mexico

Lydia Simplicio, Health Promotion Specialist
Pueblo of Zuni
P.O. Box 308
Zuni, New Mexico 87327
Phone: (505) 782-2665
FAX: (505) 782-4388

Program Description

The Zuni Wellness Center (Z W C) has earned national and international recognition as a community-based program promoting wellness and health among the native people of Zuni
In 1999, Z W C programs were featured in the I H S Primary Care Provider, the Native American Turning Point Project Newsletter and the Bristol-Myers Squibb Foundation Report entitled Extending and Enhancing Human Life. Again, the Zuni Wellness Center has earned the reputation for quality advances in fitness and health promotion.

The concepts of the Wellness Center are practical and easily replicable in other Native American communities. The Z W C staff are consultants for local and other tribal organizations. It is the hope of the Wellness Center staff that more individuals at risk for diabetes are able to participate in exercise and health promotion activities.

Community empowerment is necessary for the successful creation of a wellness campaign. Listed below are 1999 attendance figures for all fitness classes and health promotion events.

Zuni Service Unit Model Diabetes Program
Zuni, New Mexico

Scott Doughty, M D, Coordinator
P H S Indian Hospital
P O Box 467
Zuni, New Mexico 87327
Phone (505) 782-4431
Fax: (505) 782-5723
Scott.Doughty@ihs.gov

Program Description

Hospital-based program involved in clinical, research, and community activities.

Data/Epidemiology

• Approximately 1,400 people with diabetes in a service population of 9,781
• 25% of those ages 29 and older have diabetes
• 50% of those ages 49 and older have diabetes
• Active registries for diabetics, gestational diabetics, impaired glucose tolerance and "lost to follow-up" patients. Amputation registry is being developed

Clinical Accomplishments

• Weekly multi-disciplinary diabetes clinic, guided by I H S Standards of Care for Diabetes and Staged Diabetes Management
• On-site nutrition and diabetes education by appointment
• Incidence of lower extremity amputation markedly reduced (to 0%!) since podiatry clinic began 12/98.

Research

• Proposed "Health Foods First" project being formulated. Drug use evaluations (metformin/troglitazone) with immediate feedback to healthcare providers at Zuni-Ramah Service Unit
• Numerous abstracts, research and review articles published in Diabetes Care, I H S Provider, Journal of Family Practice, and others.
• Presentations at regional and national conferences

Community

• Active member of the local diabetes partnership effort to promote prevention through education and active participation in lifestyle modification.
• Other partners include representatives from:

• Most succesful and established (17 years) pr0ogram is the Zuni Fitness Series.

Education

• On-going patient/family education in clinic and office appointments
• Staff education for nurses, physicians, and physician assistants
• Community education through local radio and newspaper events
  recently produced diabetes education video
• Health fairs & school class sessions
• Zuni Fitness Series and Zuni Wellness Center events
• Meet with D W I offenders monthly to educate about diabetes/alcohol dangers
• Plan to incorporate student researchers in program activities through a National Diabetes Prevention Center effort with Dine College

Resource Development

• Assisted Zuni Wellness Center in developing materials for replicating community wellness programs which have succeeded in Zuni
• Working with other diabetes care providers in Albuquerque Area to develop treatment guidelines for diabetes, hypertension, and dyslipidemia
• Involvement with National Diabetes Prevention Center development.

Challenges

• Recognizing the proven benefit of case management for improving glycemic control, the Public Health Nursing department is assisting P H N staff members to become Certified Diabetes Educators. This effort should improve our local outreach to meet the needs of individuals having difficulty attaining the recommended level of glycemic control or meeting standards of care

Unique Contributions

• Establishment of protocols for microalbuminuria screening
• Comprehensive multidisciplinary weekly diabetes clinic with all physicians and physician assistants participating.